Provider Demographics
NPI:1215028568
Name:KEATOR, MINDY ANN (OTR)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:ANN
Last Name:KEATOR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 STATE ST
Mailing Address - Street 2:REHABILITATION TODAY
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1122
Mailing Address - Country:US
Mailing Address - Phone:814-368-5648
Mailing Address - Fax:814-368-2245
Practice Address - Street 1:101 E STATE ST.
Practice Address - Street 2:GENESIS REHABILITATION SERVICES
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348
Practice Address - Country:US
Practice Address - Phone:814-368-5648
Practice Address - Fax:814-368-4522
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013012225X00000X
PAOC008798225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00011264701OtherUNIVERA
000670162001OtherWNYBCBS
1699692OtherGHI
22361607OtherMPN EMPIRE PLAN
001547543OtherKEYSTONE SELECT BLUE
NY02532543Medicaid
PA100847694Medicaid
175626062OtherTRICARE
22361607OtherNORTH AMERICAN HEALTH PLA
223616077OtherUNITED HEALTHCARE
223616077OtherINTER GROUP
223616077OtherNOVA
223616077OtherFIDELIS
240033OtherHEALTH AMERICA
22361607OtherMPN EMPIRE PLAN